Death by American Healthcare

Richest country in the world, blah, blah, blah.  Only wealthy country that lets thousands of its citizens die every year, deaths that would have been prevented but for lack of access to affordable health care.  Only country in the world where basic medical services are a commodity, administered on a profit-based model by corporations whose sole mandate is to increase profits for shareholders.  Blah, blah, blah.    The Devil, as always, is in the details.   Death by American healthcare is not always as straight-forward as it seems.

 I vented to Sekhnet’s long-time doctor about American Corporate Medicine, and the externality that, to keep profits as handsome as they are, 50,000 Americans dying preventable deaths every year is reckoned an acceptable ‘cost of doing business.’  

“Where did you get that number?” the doctor asked.  

“The number I always hear is 45,000, but I’m hopped up because I haven’t been able to see a new nephrologist for my progressive kidney disease, so I added 5,000.”

“You can add a lot more than 5,000.  Those statistics are deaths based on documented ER visits when the disease is discovered in its final stage.   Many more Americans than that die preventable deaths every year.   You can probably multiply that 45,000 by some factor to get the actual number of Americans who die for lack of access to affordable basic health care.   How many more die without ever getting to an Emergency Room?  Those dead Americans don’t even get to be statistics,”  the doctor said.    I don’t dispute the good doctor’s point.    

As a man who has now had to change nephrologists so far three times (in less than a year), and is currently without care for my kidney disease as I look for a fourth nephrologist,  as a result of Obamacare’s immensely complicated private insurance scheme, I take Obama’s famous “if you like the doctor you have, you can keep your doctor” lie personally.  That poised, principled, hilarious, smooth-talking bitch looked me sincerely in the eye and lied to my face.  

I’d have liked to have stayed with the second nephrologist very much, instead I was forced, by income-based insurance laws, to visit one who was arrogant, defensive, insecure and argumentative.  As a result of her healthcare inexpertise, and the intricacies of the government-private insurance partnership, I am now more than two months without medical care for my progressive kidney disease, kidney disease the final nephrologist labeled an emergency case.  My kidney disease is of unknown origin, though all studies seem to agree that stress makes it worse.

“You mustn’t take these things personally,” says a random anal sphincter, passing by.  

Of course, it is absurd to think that Mr. Obama lied to me personally, offensive for me to refer to him with the gender insensitive “bitch” rather than as a dick or corporate shill.   He did his best to make positive change, President Hope and Change.   Mr. Obama was certainly a much better president than his predecessor, a limited man run by a cabal of psychopaths, and his successor, a man who needs no introduction.  

By the same math, of course, Mr. Mussolini was much better than Mr. Hitler and Mr. Stalin.   That is just hyperbole talking, a gratuitous rhetorical flourish, snapping snappishly.   Nobody is comparing any American president to these maniacs, it is a grave national insult to do so and it removes history and morality from the equation.  These were dictators, for one thing, our leader is democratically elected.   The tens of thousands, perhaps as many as a million, killed by the three most recent American presidents are not comparable to the millions killed by brutal dictators like Hitler and Stalin.  Collateral damage deaths in war zones are not the same as deliberately mass murdered civilians, even when they are the direct result of an errant smart bomb or a mistaken “signature” drone strike, or they are children who die as a result of an embargo of food and medical supplies.   A fine point to the families of the dead civilians, perhaps, but a discussion for another time.

The problem with assessing the real world effects of our presidents is that we don’t even have the language to talk about it.  Without a frame for the discussion, it is hard to understand how someone like Obama, who spoke eloquently from his heart on many matters of great public importance, at the same time steadily supported the powerful forces that run our pernicious status quo and ensured that any change proposed would be incremental, at best.  

Obama campaigned on “Hope and Change” with a slogan of “Yes We Can!”.   Campaigns and their tag-lines are pretty much PR bullshit, we all know that.   Reagan used “Make America Great Again” along with “Morning in America” and a bunch of other glittering, meaningless phrases.  Anyone who voted for Obama truly hoping for the advertised hope and change was clinging sadly to hopes inspired by a very successful marketing strategy.  Obama himself repeatedly told the people who voted for him that it was their responsibility to push him to keep his promises, though he phrased it more flatteringly to himself. 

Let’s take a glance at Obama’s presidency.  Before he was in office very long he was awarded the Nobel Peace Prize, for things he said as a candidate, presumably. When he accepted the prize he spoke eloquently about war, poverty, racism, but asked us to recognize that while he stood on Martin Luther King’s shoulders, his hands were somewhat tied.  As president, he reminded us, he would have to authorize the ongoing war on Terror, order extrajudicial killing by weaponized drones and engage in other violent policies Reverend King might not have approved of.   He humbly asked us to remember that there is only so much an American president can do about the institutional violence of militarism, racism and poverty.

“Everyone knows you don’t mess with the American war machine.   War is deadly serious bucks, man, it’s a powerful, lucrative industry with unlimited clout and, truly, if we’re completely honest about it, you cannot separate the American war machine from racism and poverty, and if I tried to, particularly as the first black president, I’d be a dead man, I promise you,” is something he didn’t need to add.

The reason my disgust for Obama exceeds my disgust for Dubya is that I expected nothing from the strikingly incurious Dubya and I expected something from Obama.  Obama might have come into office and turned the page back towards a world order based on international law, as most of the world was keeping its fingers crossed he would, for example.   This was the direction international law was headed when Mr. Bush took office in 2000, pursuant to a one-off Supreme Court decision declaring him the winner of a close and disputed election.  The Bush administration went on to flout international law, create a novel doctrine called Preemptive War, commit war crimes (with full preemptive legal immunity for the perpetrators), and serially violate the Geneva Conventions and other international treaties against torture and inhumane treatment.  

Obama took the high road, promising to look forward, not backwards, refusing to hold anyone accountable for the atrocious state policies carried out in our name.  Eventually he had the personal courage to publicly acknowledge that, in those confusing days after 9/11, and with the best of protective intentions, “we tortured some folks.”   Good speech, bro.

The term we are searching for is neoliberal.   Bill Clinton was a neoliberal. He was liberal on social issues: a woman’s right to choose, freedom from discrimination, protection of civil rights and the social safety net, proactive policies on Climate Change and environmental protection, gay rights, pubic education, access to affordable health care, freedom of speech and expression, etc.  He was neoliberal when it came to economic policies that disfavored corporate power– he took action during his presidency to ensure that large financial interests prospered.  He smiled as he reported great economic growth on his watch and claimed that a rising tide lifts all boats.  

He also signed several key pieces of right-wing legislation that did a lot of harm to the poor and swelled the bloated U.S. prison population, disproportionately with people of color.   He had the charisma to carry it off and to be remembered as a popular liberal president.    Until Obama, many called Clinton our “first black president”.   He was a neoliberal, a social liberal capable of forming alliances with the extreme right in the interest of promoting the continued growth of the “Free Market”.

President Bush didn’t have much to do, from an economic point of view, when he took over in 2001.   He cut taxes for the very rich, as anyone in his position would have, but Wall Street was humming, as it had been under Clinton.  Clinton signed off on the repeal of Glass-Steagall, which freed the biggest financial institutions to make risky, highly leveraged bets, backed by federally guaranteed money.  This led directly to the great scam that ended in the multi-gazillion dollar losses to Americans in concerted, industry-wide fraud by businesses too big to fail and the bailout of these crooked institutions by those same taxpayers.  

Obama presided over the aftermath of this, but nobody was ever prosecuted for the massive, coordinated fraud, the vast transfer of wealth to the wealthiest.   No serious policy changes were instituted to prevent a repeat, as Wall Street stabilized itself.   Obama’s financial brain trust was from Goldman-Sachs and the other top beneficiaries of the taxpayer bailouts.  Everybody who really mattered did very well under Obama, who also continued most of Cheney’s secretive policies, while giving moving speeches about the need for government transparency in a true democracy. The disgruntled masses who got a little poorer?  They are always belly-aching.

Neoliberalism, in matters of basic profit-making by corporations, the entities that are said to create all wealth in the “Free Market,” is identical to neoconservatism.    Their interests meet in their central belief that corporate freedom to thrive in a Free Market is essential to our way of life. For the market to remain free, government policy must give these corporations many protections, such as subsidies to oil companies, payments for agribusiness not to grow certain crops, no-bid emergency contracts, tax incentives, right to unlimited campaign contributions, a revolving door between industry and government to influence policy, financial bail-outs when their scams go south and so forth.  

Why is it called the “Free Market” if the government has to play such a key role in its operation?  

Because, if we told you the truth, the whole truth and nothing but the truth, it would make you want to rise up and smash our faces.  It really would.  

That’s why.

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